From the Guidelines
Hematochezia is defined as the passage of fresh, bright red blood from the rectum, typically mixed with or coating stool, indicating bleeding from the lower gastrointestinal tract. This symptom is a significant indicator of potential health issues, including hemorrhoids, anal fissures, diverticular disease, inflammatory bowel disease, colorectal polyps or cancer, and angiodysplasia 1. The bright red appearance of the blood occurs because it hasn't traveled far enough through the digestive system to be altered by digestive enzymes. Any instance of hematochezia warrants medical evaluation, especially if accompanied by other symptoms like abdominal pain, changes in bowel habits, or signs of blood loss such as dizziness or fatigue 1. The urgency of evaluation depends on the amount of bleeding, with massive hematochezia requiring immediate emergency care due to potential hemodynamic instability. According to the most recent guidelines, colonoscopy is recommended for the diagnostic evaluation of individuals with hematochezia 1. This approach is supported by recent studies, which have found that colonoscopy is the most effective method for diagnosing the cause of hematochezia, especially in high-risk patients 1. In contrast, the use of alternative diagnostic modalities, such as fecal immunochemical tests (FIT), is not recommended for symptomatic patients due to the potential for delays in diagnosis and the increased risk of advanced-stage disease 1. Overall, prompt medical evaluation and colonoscopy are essential for patients presenting with hematochezia to ensure timely diagnosis and treatment of the underlying cause.
From the Research
Definition of Hematochezia
- Hematochezia is defined as the passage of blood or clots from the rectum 2.
- It is also referred to as an acute and chronic lower gastrointestinal bleeding 3.
- Hematochezia is characterized by the passage of bright red blood per rectum 4.
Causes of Hematochezia
- Hematochezia can be caused by various factors, including diverticulosis, angiodysplasia, neoplasm, perianal disorders, Meckel's diverticulum, colitis, intussusception, and others 3.
- In elderly patients, angiodysplasia of the colon is one of the most common causes of major lower intestinal tract bleeding 5.
- Hematochezia may be associated with an anal cause in most healthy young adults, but some may end up being diagnosed with colorectal cancer (CRC) 2.
Clinical Presentation and Diagnosis
- The clinical presentation of hematochezia can vary, ranging from hematochezia or melena to iron-deficiency anemia resulting from long-term blood loss 5.
- Accurate diagnosis may require a combination of diagnostic techniques, such as angiography, nuclear scanning, and colonoscopy 5.
- Colonoscopy is a useful tool for identifying the etiology of hematochezia and predicting outcomes 6.
- Flexible sigmoidoscopy can demonstrate most substantial lesions in patients with hematochezia 4.